Targeted vs opportunistic screening for viral hepatitis among UK migrant communities: a cost-effectiveness analysis

Worldwide eradication of chronic hepatitis B and C viruses by 2030 is a stated goal of the World Health Organization, UK government and the European Union. This study investigated the cost-effectiveness of targeted screening vs opportunistic screening for hepatitis B and C among migrant populations in the UK. Results of a previous clinical trial (HepFREE) carried out in London and Bradford were used to develop a combined decision tree and Markov simulation model. Despite a low response to invitations for vaccination, and a heterogeneous level of response between communities of different ethnic composition, this analysis shows that incentivised targeted screening is cost-effective at willingness-to-pay thresholds over £8540 per incremental quality-adjusted life year over a lifetime. Furthermore, probabilistic analysis of input parameter uncertainty suggests that the intervention has a greater than 95% probability of being cost-effective at willingness-to-pay thresholds under £30 000 per incremental quality-adjusted life year. These results strongly suggest that targeted screening should play a key part in the eradication of the hepatitis B and C viruses.